2020 Volume 53 Issue 2 Pages 154-163
A 15-year-old adolescent girl was transported to our hospital because of abdominal pain and vomiting. Abdominal CT showed coprostasis in the rectum and the sigmoid colon. The small and large intestine were markedly extended and filled with content fluid. Colonoscopy with intestinal lavage showed the mucosa of the sigmoid colon turning purplish or blackish. Under the diagnosis of stercoral obstructive colitis with colonic ischemia, emergency laparotomy was performed. The colon was studded with spotty ischemic changes. Removal of feces and irrigation in the colon with intraoperative colonoscopy improved the mucosal appearance. Total colon was preserved and diverting ileostomy was performed. Intensive care after surgery improved her general status. Colonoscopy with enema on day 25 and day 85 showed severe stenosis at the right side of the transverse colon and the lead-pipe appearance from the left side of the transverse colon to the descending colon. Irreversible colonic stenosis was suspected, and subtotal colectomy was performed on day 103. The resected colon was compatible with ischemic colitis by the naked eye and histopathologically. After ileostomy closure on day 138, she returned to her school life. We report the youngest case of stercoral obstructive colitis in Japan with a literature review of 20 cases.
